MEDICARE: DR. STANTON MARC BRAID D. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS018002L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0060873000	OTHER	PA	PA BC-BS- KHPE-PERSONALCH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205824398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANTON MARC BRAID D. M.D.

Provider Business Mailing Address
First Line	:	1521 LOCUST ST
Second Line	:	SUITE 600
City	:	PHILA
State	:	PA
Zip	:	19102-3727
Country	:	US
Telephone Number	:	215-735-6241
Fax Number	:	215-735-6242

Provider Business Practice Location Address
First Line	:	1521 LOCUST ST
Second Line	:	SUITE 600
City	:	PHILA
State	:	PA
Zip	:	19102-3727
Country	:	US
Telephone Number	:	215-735-6241
Fax Number	:	215-735-6242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	03/13/2016

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